Objective: To explore the value of transthoracic echocardiography (TTE) and three-dimensional transesophageal echocardiography (3D-TEE) in diagnosis of bicuspid aortic valve (BAV) combined with infective endocarditis (IE). Methods: Ultrasonic data of 53 BAV combined with IE patients were retrospective reviewed. The ultrasonic findings of BAV combined with IE included vegetation, leaflet perforation, abscess and fistula. The ultrasonic features and diagnostic value of TTE and 3D-TEE were evaluated taken surgical findings as the gold standards. Results: The sensitivity and positive predictive value of 3D-TEE were both higher than those of TTE in detecting vegetation, leaflet perforation, abscess and fistula (100% vs.90.20%, 96.87% vs.90.62%, 92.86% vs.67.86%, 94.12% vs.70.59% and 100% vs.95.83%, 100% vs.93.55%, 96.30% vs.86.36%, 100% vs.85.71%, all P<0.05). Conclusion: The echocardiographic detection rate of BAV combined with IE is very high. 3D-TEE has better visibility and higher spatial resolution than TTE, therefore having higher sensitivity and positive predictive value in diagnosis of BAV combined with IE.

Objective To investigate the impact of accelerator′s multi-leaf collimator (MLC) on the radiotherapy dose with different gantry angles.Methods Measured with Mapcheck 2D diode array and 30 cm×30 cm×3 cm solid water, Pre-selecting the 30 appropriate single fields and 0°,45°,90°,270°,315° gantry angles of static and dynamic intensity modulated radiation therapy (IMRT), quantification analysis of the passing rate with MapCheck γ(3%/3 mm) and (5%/3 mm) analysis methods, and the same method to 30 examples static and dynamic IMRT plans.Results When the accelerator collimator angle is 0°,the 30 appropriate single fields′ passing rate of between 0°gantry angle and 45°,90°,270°,315°gantry angles of static and dynamic IMRT accordingly is 97.71% and 96.25%(t=1.70, P=0.389), 96.34% and 93.72%(t=2.95, P=0.002), 96.65% and 92.98%(t=2.87, P=0.005), 95.87% and 93.15%(t=2.71, P=0.006), 96.09% and 93.51%(t=2.89, P=0.004) with MapCheck γ(3%/3 mm) analysis methods, however, the passing rate also does not have the difference, respectively is 99.31%-99.73% and 98.89-99.68%(t=0.57-1.90, P=0.913-0.725) with MapCheck γ(5%/3 mm) analysis methods;the passing rate of 30 examples static and dynamic IMRT plans accordingly is 96.11%-96.76% and 94.88%-95.78%(t=1.02-1.61, P=0.317-0.235).Conclusions When the accelerator collimator angle is 0°, at different gantry angles, MLC leaves due to gravity, friction, inertia, etc caused by errors in place, the physical penumbra and leakage radiation will indeed affect the IMRT dose, however, the deviation of dose distribution is within acceptable 5%.

Objective To compare the results of CT/MRI registration by using two different marker materials. Methods CT and MR transversal images (using electric wire and thin tube filled with lohexol injection as matching points respectively) were obtained from nine cases with brain tumor. Another CT and MR transversal images were also obtained by using the cod-liver oil capsule filled with gadopentetate dimeglumine injection as matching points with the same scanning position. The images were transferred to the TPS for image registration and the effect was evaluated. Results The CT/MRI CRE range for using different kinds of marker material was 0.16-0.28cm,while was 0.06-0.16cm for using the same marker material. Conclusion Comparing with the method using different kinds of material,the method using the same spherical material can get better results in CT/MRI registration.

Objective: To explore the position change of the setup reference markers on the sternum due to the change of hands grip position. Methods: Six hands grip positions were simulated for 8 patients and the set-up reference points marked on the sternum skin were compared while the hands grasped different positions of the hands. Results: The setup markers on the sternum were deviated by all five hands grip positions. The maximum deviated distance was 14mm. Conclusion: The change of the hands grip position can affect the position of setup reference markers on the sternum of the patients and thus the isocenter of plan may be aligned to the wrong area.

In the context of global warming, the frequency, intensity, and duration of heatwaves will further increase. In recent years, plenty of studies have suggested from diversiform perspectives that heatwaves may increase mortality risk. However, the focuses of current studies on heat wave and human health are scattered, and a systematic theoretical framework has not yet been formed. We therefore systematically reviewed the previous literature in terms of possible mechanism paths and vulnerability mechanism of heatwave increasing mortality risk, summarized the vulnerability factors that influence exposure opportunities, constrain adaptive capacity, as well as affect physiological responses and behaviors. We further attempted to propose a theoretical framework from the processes of "exposure degree-modification effect-physiological behavior-health outcome". This paper summarized the research directions on heatwaves and health, which can provide ideas for future in-depth health risk assessment and adaptation to climate change.

BACKGROUND: High on-treatment platelet reactivity (HTPR) has been suggested as a risk factor for patients with ischemic vascular disease. We explored a predictive model of platelet reactivity to clopidogrel and the relationship with clinical outcomes. METHODS: A total of 441 patients were included. Platelet reactivity was measured by light transmittance aggregometry after receiving dual antiplatelet therapy. HTPR was defined by the consensus cutoff of maximal platelet aggregation >46% by light transmittance aggregometry. CYP2C19 loss-of-function polymorphisms were identified by DNA microarray analysis. The data were compared by binary logistic regression to find the risk factors. The primary endpoint was major adverse clinical events (MACEs), and patients were followed for a median time of 29 months. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the patients with HTPR and non-HTPR. RESULTS: The rate of HTPR was 17.2%. Logistic regression identified the following predictors of HTPR: age, therapy regimen, body mass index, diabetes history, CYP2C192, or CYP2C193 variant. The area under the curve of receiver operating characteristic for the HTPR predictive model was 0.793 (95% confidence interval: 0.738-0.848). Kaplan-Meier analysis showed that patients with HTPR had a higher incidence of MACE than those with non-HTPR (21.1% vs. 9.9%; χ = 7.572, P = 0.010). CONCLUSIONS Our results suggest that advanced age, higher body mass index, treatment with regular dual antiplatelet therapy, diabetes, and CYP2C192 or CYP2C193 carriers are significantly associated with HTPR to clopidogrel. The predictive model of HTPR has useful discrimination and good calibration and may predict long-term MACE.
Aged ; Blood Platelets ; drug effects ; Clopidogrel ; pharmacology ; therapeutic use ; Coronary Artery Disease ; metabolism ; prevention & control ; Cytochrome P-450 CYP2C19 ; metabolism ; Female ; Genotype ; Glycated Hemoglobin A ; metabolism ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; metabolism ; prevention & control ; Regression Analysis

Objective    To investigate the effectiveness and safety of totally endoscopic transmitral myectomy (TETM) for hypertrophic obstructive cardiomyopathy (HOCM), comparing with traditional sternotomy modified Morrow procedure (SMMP). Methods    Thirty-eight patients with HOCM who needed surgical intervention were selected from our hospital in 2019, including 14 males and 24 females, with an average age of 56 (44-68) years. According to the operation method, they were divided into a TETM group (n=18) and a SMMP group (n=20). Appropriate patients  were screened by propensity matching scores. Finally, the clinical data of two matched groups were compared and

OBJECTIVETo compare the effects of puerarin and granulocyte colony-stimulating factor (G-CSF) in treating acute myocardial infarction (AMI) and on the size of infarcted area and cytokines.

METHODSSeventy-nine patients with anterior AMI were randomly divided into three groups, they were treated with conventional Western medical treatment, but to the puerarin group (PG) and the G-CSF group (GCG) puerarin and G-CSF was given additionally, respectively. The infarcted size, plasma G-CSF, matrix metalloproteinase-9 (MMP-9), serum interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were detected before and after treatment.

RESULTSThe infarcted size was positively correlated to the levels of G-CSF, MMP-9, IL-6 and TNF-alpha before treatment ( r = 0.45, 0.42, 0.44 and 0.42, P<0.01 ). The infarcted size in the PG and the GCG decreased on the 28th day (P<0.01), the level of G-CSF, MMP-9, IL-6 and TNF-alpha in the PG on the 7th day all decreased (P<0.05), but these indexes in the GCG increased (P<0.05), while those in the control group were unchanged (P>0.05).

CONCLUSIONPuerarin and G-CSF are effective in decreasing infarcted size, but their effects on cytokines are different entirely.

Aged ; Antigens, CD34 ; metabolism ; Drug Therapy, Combination ; Female ; Granulocyte-Macrophage Colony-Stimulating Factor ; therapeutic use ; Humans ; Interleukin-6 ; blood ; Isoflavones ; therapeutic use ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Myocardial Infarction ; drug therapy ; Phytotherapy ; Recombinant Proteins ; Tumor Necrosis Factor-alpha ; metabolism

ObjectiveTo investigate the factors influencing the liver histological features in chronic hepatitis B virus (HBV) infection patients with low alanine transaminase (ALT) levels by analyzing the relationship of serum hepatitis B surface antigen (HBsAg) level with liver inflammation grade and fibrosis stage. MethodsA total of 511 HBV infection patients admitted to our hospital from December 2010 to December 2013 were studied. The liver histological features, serum HBsAg level, and HBV DNA copy number were examined. Comparison of categorical data between different groups was made by chi-square test, comparison of continuous data following the normal distribution was made by t test, and comparison of continuous data not following the normal distribution was made by Kruskal-Wallis H test. The relationship of serum HBsAg level with liver inflammation grade and fibrosis stage was determined by Spearman′s rank correlation analysis. ResultsAll patients showed different degrees of hepatic histological abnormalities. The group aged more than or equal to 40 years had significantly lower HBeAg positive rate, HBsAg level, and HBV DNA copy number compared with the group aged less than 40 years (χ2=86.8, P＜0000 1; t=2.99, P=0.003; t=7.25, P＜0.000 1). The groups with different ages had significant differences in liver inflammation grade and fibrosis stage (χ2=70.03, P＜0.000 1; χ2=61.92, P＜0.000 1). The Spearman′s rank correlation analysis indicated that in both HBeAg-positive and -negative patients HBsAg level was negatively correlated with liver inflammation grade (r=-0.245, P＜0.000 1; r=-1.51, P=0019) and fibrosis stage (r=-0.153, P=0.012; r=-0.181, P=0.005). ConclusionAge is one of the important factors influencing the liver histological progression in chronic HBV infection patients with low ALT levels. HBsAg level is negatively correlated with liver inflammation grade and fibrosis stage in chronic HBV infection patients with low ALT levels, so it could be used as an important non-invasive indicator for the liver histological status in these patients.

Occupational silicosis features as irreversible pulmonary fibrosis, which is caused by long-term inhalation of free silica dust. The pathogenesis of silicosis is complex and there is no cure at present. Traditional Chinese medicine classifies silicosis fibrosis into the category of diseases as "pulmonary paralysis" and "pulmonary arthralgia", and its treatment is based on promoting blood circulation and activating qi. Traditional Chinese medicine for activating blood circulation is one of the commonly used medications, which has the effects of anti-oxidation, anti-inflammation, anti-fibrosis and immunomodulation, and has broad application prospect in the prevention and treatment of silicosis. At present, animal experiments and clinical studies have been carried out using the single Chinese herbs extracts that could activate blood circulation such as Salvia miltiorrhiza, Ligusticum chuanxiong Hort., Panax notoginseng, Curcuma longa L., peach kernel and Carthamus tinctorius L. as well as their compound herbs for the prevention and treatment of silicosis. The mechanisms of anti-pulmonary fibrosis and the efficacy and safety of treating silicosis and its complications were explored. There are also scholars studying Salvia miltiorrhiza, Curcuma longa L. and Danhong injection, Taohong Siwu Decoction and others for prevention and treatment of pulmonary fibrosis. Additionally, network pharmacological research, analyzing potential targets and pathways, were carried out to provide scientific rationale for prevention and treatment of silicosis. However, the effectiveness of research is still uncertain, and it cannot meet the clinical needs. In the future, it is necessary to explore the application of more high-quality active components of traditional Chinese medicine monomer or mixture of activating blood circulation in the prevention and treatment of silicosis, to provide new ideas and scientific basis for the prevention and treatment of silicosis using traditional Chinese medicine.